-
Jul2
A Critique of the Extreme-Male-Brain Theory of Autism
25 CommentsIn his 1999 paper The extreme-male-brain theory of autism, Professor Simon Baron-Cohen posits a dichotomy between the empathizing female brain and the systematizing male brain. In Baron-Cohen’s theory, autistic people have extreme versions of the systematizing male brain.
Baron-Cohen begins his paper with an introduction characteristic of many articles about autism and autistic people:
“Autism is widely regarded to be the most severe of the childhood psychiatric conditions (Rutter, 1983; Frith, 1989; Baron-Cohen, 1995). It is diagnosed on the basis of abnormal social development, abnormal communicative development, and the presence of narrow, restricted interests, and repetitive activity, along with limited imaginative ability (DSMIV, 1994). Such children fail to become social, instead remaining on the periphery of any social group, and becoming absorbed in repetitive interests and activities, such as collecting unusual objects or facts. It is a tragedy for their families who work tirelessly to attempt to engage with and socialize their child, mostly with very limited results.” (Baron-Cohen, 3)
Let’s consider the professor’s assumptions and omissions:
1) Baron-Cohen characterizes autism as “the most severe of the childhood psychiatric conditions.” However, autism is not a psychiatric condition, nor is it limited to children. It is a neurological condition with which we are born, and with which we live throughout our lives.
2) The professor describes autism mainly by pointing to external markers: social development, communicative development, and the presence of restricted interests and repetitive activity. The only mention of our internal processes is the remark that we have “limited imaginative ability,” which is not even the case in all instances. Take a look at the work of autistic artists all over the world and you will see a level of imagination that eludes most people, including professors at major universities.
However, the author’s omissions are even more telling than his words. Nowhere does he mention our sensory sensitivities, our unusual communicative or cognitive abilities, our capacity for rational thought, our empathy, our gifts, the love we feel for others, or any other process that goes on in the human mind and heart. To see autistic people only by external markers shows a significant lack of empathy in every sense of the word.
3) Autism is “a tragedy for…families who work tirelessly to attempt to engage with and socialize their child, mostly with very limited results.” Our very existence, apparently, is a tragedy. Autistic people, of course, have no feelings, no struggles, and no tragedies of our own. We just cause other people pain and suffering.
Once he gets done slandering us, Simon-Cohen adduces a number of questionable arguments for his extreme-male-brain theory—arguments with which he seeks to prove that autistic people have odd versions of male brains:
“(i) Normal males are superior in spatial tasks compared to normal females, and people with autism or Asperger Syndrome are even better on spatial tasks, such as the Embedded Figures Test (Jolliffe and Baron-Cohen, in press).” (Baron-Cohen, 33)
Any difference in abilities between males and females can easily be explained not by brain structure, but by the ways in which girls are socialized and educated in western societies. The conclusion that neuro-typical males are innately superior to neuro-typical females in spatial tasks ignores the effects of culture, context, and socially imposed gender roles.
Moreover, many autistic people have very poor spatial abilities. I am autistic, but my spatial abilities are quite limited. I failed Calculus because I couldn’t rotate three-dimensional objects in my mind. I still can’t. My mind works only in two dimensions. I can see height and width, but not depth.
“(ii) There is a strong male bias in the sex ratio of autism or AS.” (Baron-Cohen, 33)
As Tony Attwood and others have shown, female Aspies tend to have an entirely different presentation from males. The diagnostic criteria were developed from the results of studies using only males. All of Leo Kanner’s subjects and Hans Asperger’s subjects were boys. The male bias lies in the diagnostic markers, not in the condition of autism itself.
“(iii) Normal males are slower to develop language than normal females, and children with autism are even more delayed in language development (Rutter, 1978).” (Baron-Cohen, 33)
People with Asperger’s, by definition, do not have language delays. Given that Asperger’s Syndrome is autism by a different name, and that more than half of all autistic people have Asperger’s, it’s impossible to make the claim that the language development of all autistic people is delayed.
“(iv) Normal males are slower to develop socially than normal females, and people with autism are even more delayed in social development (O’Riordan, Baron-Cohen, Jones, Stone, and Plaisted, 1996).”
Baron-Cohen fails to question the reason for the lag in normative male social development. Is it nature or nurture? Since girls are socialized to cooperate, and boys are socialized to fight, it’s clear that nurture plays a large role in helping girls develop better social skills than their male counterparts.
“(v) Normal females are superior to males on mindreading tasks, and people with autism or AS are severely impaired in mindreading (see Baron-Cohen et al, 1996).”
It’s true that most people with autism cannot figure out the mental states of other people from nonverbal cues. It’s also true that Baron-Cohen, despite his obsession with the external behaviors of autistic people, is unable to figure out our mental states at all. Does that make him autistic? After all, he’s a man and he can’t read our minds.
I rest my case.
“(vi) Parents of children with autism or AS (who can be assumed to share the genotype of their child) also show superior spatial abilities and relative deficits in mindreading (i.e., a marked male brain pattern (Baron-Cohen and Hammer, in press b).”
If the female, non-autistic parent has superior spatial skills, doesn’t that disprove that such skills are inherently male?
“(vii) Normal males have a smaller corpus callosum than normal females, and people with autism or AS have an even smaller one (Egaas, Courchesne, and Saitou, 1994).”
A 1997 study by Professors Bishop and Wahlsten at the University of Alberta showed that, on average, the corpus callosum is larger in males, not smaller. According to the article, “Data collected before 1910 from cadavers indicate that, on average, males have larger brains than females and that the average size of their corpus callosum is larger…The recent studies, most of which used magnetic resonance imaging (MRI), confirm the earlier findings of larger average brain size and overall corpus callosum size for males. The widespread belief that women have a larger splenium than men and consequently think differently is untenable.”
“(viii) Left handedness is more common among males, and people with autism or AS show an elevated incidence of left-handedness. Fein, Humes, Kaplan, Lucci, and Waterhouse (1984) found an 18% incidence of left-handedness in autism. Satz and colleagues (Satz, Soper, Orsini, Henry, and Zvi, 1985; Soper, Orsini, Henry, Zvi, and Schulman, 1986) found a very similar picture: in their autistic sample, 22% were left handed.”
I didn’t find any of the previous criteria compelling in the least, but now that we’re talking about left-handedness, I really have to give the professor his due.
Yes, my friends, I am left-handed and autistic.
Of course, my mother, who was also left handed, was not autistic. My father, who was not left-handed, was almost definitely autistic. And my mother’s parents, both of whom were left-handed, were neuro-typical. But why throw in such annoying details when the proof is sitting right in my left hand?
“(ix) In the normal population, the male brain is heavier than the female brain, and people with autism have even heavier brains than normal males (Bailey et al, 1994).”
Apparently, to Professor Baron-Cohen, size matters.
“(x) In the normal population, more males are found in mathematical/mechanical/spatial occupations than females. Parents of children with autism or AS are disproportionately represented in such occupations (Baron-Cohen, Wheelwright, Bolton, Stott & Goodyer 1996). These occupations all require good folk physics whilst not necessarily requiring equally developed folk psychological skills.”
Like his first conclusion, his final one ignores the effects of culture and context. Girls are socialized and educated to follow paths that do not involve mathematical, mechanical, or spatial skills. No proof exists that females, by nature, find it difficult to acquire these skills. None.
In addition to the faulty evidence that Baron-Cohen adduces, there are three general problems with his theory:
1) He employs a dichotomy between the empathizing female brain and the systematizing male brain. Apparently, he has never considered the idea that systematizing and empathizing could exist in extreme measure in the same brain. His theory leaves out those of us who both systematize and empathize in non-normative ways.
For example, like many autistic people, I systematize constantly, and I also have extreme amounts of empathy. Where do I fit in his paradigm? Nowhere.
2) The theory assumes that our autistic brains are an odd version of non-autistic brains. Baron-Cohen doesn’t consider the obvious fact that autistic brain development and cognitive abilities are substantially different from those of neuro-typical people. He takes a brain structure that he considers “normal” (i.e. his own), and then he decides that any other type of brain must simply be a variation of the norm.
3) Baron-Cohen utterly ignores the fact that men are socialized to be analytical, practical, and unemotional, while women are socialized to be intuitive, emotional, and sensitive. Because Baron-Cohen, like many of his peers in the academic and scientific communities, remains oblivious to the cultural context in which he operates, many autistic women still go undiagnosed. We’re just not “male” enough to show up on his radar.
Like the insult that autistic people lack empathy, a theory that leaves autistic women undiagnosed is not simply wrong. It has serious consequences for our well-being.
In my opinion, most autism “experts” fail to understand autism. The academics and scientists who study us, observe us, test us, and wring their hands over us are neuro-typical. Therefore, they cannot intuitively understand our internal processes and experiences. The best of them listen and learn. The worst of them publish incorrect—and damaging—conclusions.
For my own part, I’ve gotten the best information from other autistic people. We are the true experts on autism. Just as even the most sensitive man cannot be an expert on what it’s like to be a woman, so even the most sensitive neuro-typical person cannot be an expert on what it’s like to be autistic. It’s simple neurology. It can’t be done.
© 2009 by Rachel Cohen-Rottenberg
25 Responses to “A Critique of the Extreme-Male-Brain Theory of Autism”
-
Brilliant and witty as usual, Rachel.
In his defense, let me say that Simon Baron-Cohen seems to have evolved somewhat in his views on autism in the past ten years; I don’t recall exactly where I read it, but I recently read a quote from him in which he expressed the view that autistic brains are a valid but different way of being wired. Let me search a little….okay, here’s an article where he does that–skip to the last four paragraphs, which begin
“Baron-Cohen’s hope is that autism will eventually come to be understood as part of the individual differences between people.”
Second point in his defense is that he’s related to the absolutely brilliant and ballsy Sacha Baron Cohen.
-
i sometimes have had trouble with Baron-Cohen’s conclusions, but agree with Saja that his views seem to have changed somewhat recently, and recognize the above quote. after all, the paper is ten years old, but it was one that i stressed over when i read portions.
“Apparently, he has never considered the idea that systematizing and empathizing could exist in extreme measure in the same brain.”
hello!? thanks for saying this Rachel. i’ve been saying/bleating this for many many years before my diagnosis. it seems a prevalent attitude in our culture that traits are an either/or kind of thing. it goes along with the male/female, right brain/left brain, creative/analytical dichotomies that prove so popular. this is all so much garbage, and i can prove it, just by looking inside my very own dichotomous brain. is anybody asking, or just ignoring? am i now in an even smaller minority? “brain-balanced, creative/analytical genius”? will someone pay me big bucks now?
-
I’m not convinced that Baron-Cohen has moved that far along. He certainly appears to pay lip service to the idea of respect for difference, but he’s still leaving the unique, subjective experience of autistic people out of the diagnostic process:
“All the biomedical research that is going on into autism – at the level of genetics, proteins, hormones – involves the search for so-called biomarkers, because at the moment you diagnose autism on the basis of behaviour not biology. You interview the child or the adult, you interview their family, you observe them, but it’s all behavioural and observational. It is argued that biomarkers might make diagnosis more precise.”
His only alternative to depending on behavior and observation is to hope for biological markers. While he uses interviews, only very limited information is going to come out of an interview by a doctor who doesn’t realize that the paradigm from which his questions derive may not even touch the experience of the person he’s attempting to diagnose. He is still looking at us from the outside. I don’t see a lot of evidence that he’s willing to put aside his neuro-typical paradigm and see that we are not just interesting variations from the norm, but people with a fundamentally different way of seeing and being.
It’s like someone believing they can understand Jewish people by following us around, observing us, and interviewing us on the basis of their own religious paradigm without ever understanding that we have a different one. I know people who think they understand Jewish people because they’ve read the so-called “Old Testament.” They’ve never questioned whether we might view the world through an entirely set of assumptions and experiences. They’ve never even questioned whether the term “Old Testament” might be insulting to us.
However, I do agree that the man gets points because he has an amazing cousin.
-
Regarding the Extreme-Male-Brain theory paper being ten years old:
1. Baron-Cohen’s 2009 paper “Autism: The Empathizing–Systemizing (E-S) Theory” is an extension of his previous work, building upon and repeating several points from the earlier paper. His paradigm doesn’t seem to have changed much, if at all. He is still insisting upon the mind-blindness and impaired empathy theories of autism, and he still holds to the idea of a systematizing/empathizing dichotomy. You can find the later paper at:
http://autismresearchcentre.com/docs/papers/2009_BC_nyas.pdf
In the later paper, he seems to think that he can erase the “stigma” of autism by continuing to broadcast our so-called empathy deficits while playing up our systemizing skills. It’s like saying, “Yes, autistic people don’t know or care how you feel, but look at how well they take apart gadgets and reassemble them!” I do not find that comforting, especially because I wouldn’t dare take anything apart and try to reassemble it. I might scavenge it for things I can use in my art, but that’s as far as I’d go.
Baron-Cohen even lists certain stims (like rocking) as systemizing activities rather than sensory-soothing activities.
He still doesn’t get it.
2. The only critiques of the Extreme-Male-Brain theory and E-S theory that I can find on the Internet are by autistic people, which leads me to wonder whether we are the only ones who find these theories problematic.
-
John Dale Lyons July 2nd, 2009 at 12:11 pm
According to Borat’s cousin, I am either not autistic or not a male. I am very weak on spatial and mathematical tasks, but very strong verbally, like female autistics. While one can generalize that men tend to do this or have that ability, it comes down to the individual. Some women are engineers, and some men are poets. I distrust these generalities because I buck the trends yet don’t feel any less masculine or less autistic.
-
Rachel – I don’t doubt that Baron-Cohen is still enamored of his “male brain” theory; I just meant to say that he seems to have migrated from seeing autism as a “tragedy” for families to seeing it as a viable but different way of being. But that’s just based on some sound bites he’s given interviews, which may not honestly reflect his true views.
John – I’m very strong mathematically and verbally, and also very creative (drawing, writing, painting). I think lots of people, autistic or not, have coexisting skills that Baron-Cohen’s theories seem to position as either-or skills. Of course, he’s generalizing in order to have a theory that applies to autistics in general, so maybe there is *some* truth to what he is saying….I don’t know, since I don’t know any other autistics in real life, and perhaps the ones of us blogging are a skewed sample.
-
Thank goodness awareness is growing and these antiquated ideas are being overcome, if slowly. I’ve always struggled with the idea that autistic individuals are somehow sad, and that it is a burden on their loved ones that they are autistic. I think this is shortsighted and selfish, and relies entirely too much on appearances. That saying about not judging a book by its cover should apply to everyone. People just seem to forget.
Well written, Rachel
-
great writing yet again, rachel
talking about nt experts on autism: have you seen the report of the DSM-V work group for neurodevelopmental disorders?
http://www.psych.org/MainMenu/Research/DSMIV/DSMV/DSMRevisionActivities/DSM-V-Work-Group-Reports/Neurodevelopmental-Disorders-Work-Group-Report.aspxit starts off promising, one of the changes being exactly what you’re saying about taking age, gender and cultural factors into account, but where are the criteria regarding sensory issues? and it may be just me but does “intellectual disabilities” really sound better than “mental retardation”?
-
I’ve never agreed with the extreme male brain theory. It doesn’t make sense to me – and you’ve done such a brilliant job arguing the point that there’s not much point in my expanding on it.
Apart from the guts of the theory though, I personally think that the name alone has got to be demeaning to women. Surely aspie women don’t want to be considered “male-women”. How insulting.
-
If they included sensory issues, they’d have to listen to how we experience the world, instead of making (un)educated guesses about what our behavior might mean. The guesses usually involve interpreting the behavior as though it were coming from a neuro-typical person. I mean, how exactly does rocking rate as a systemizing behavior? What do they think is happening, that we’re pretending we’re metronomes set to various speeds?
When a mother rocks a baby to sleep, she’s not pretending the kid is a pendulum. She’s soothing the baby so that they both can get some rest. It’s happened all over the world since humans first walked the planet. It’s beyond my ability to understand how anyone could think we’re doing anything other than soothing ourselves in a way that comes naturally to human beings.
I agree on the “intellectual disabilities” issue as well. I can’t even figure out what the term means. I don’t feel like anything is amiss with my intellect. My sensory system is a wee bit on the sensitive side, but my mind is doing just fine. It catches fire occasionally, but then I stop reading papers by autism experts and I feel much better.
-
Jennifer July 3rd, 2009 at 4:26 am
Rachel, I wish that you could contact S.Baron-Cohen and have a dialogue with him.
If you ever get the chance, please do….. -
i suppose i’m at the point where i don’t expect anybody, even the leading researchers to listen, or take what we say seriously. we could be deluding ourselves. it is common for us to prize intellectual gifts very highly, which could explain why i feel so cheezed off when it’s suggested that something is wrong with the way my mind works.
mind-blindness, lack of empathy, male-brain, these all really bug me, but in the spirit of scientific theory, i can’t say that they can’t be true, at least for some.
the important thing i try to remember is that they aren’t true for me. well, at least the mind-blindness and lack of empathy. i don’t show typical male-brain traits either, being an analytical, creative, short-tempered, logical, distractable, word-obsessed crybaby, but i can’t actually scan my brain to see (but wouldn’t that be neat?)we fall prey to the human tendency to label and categorize as much, or more, than anybody else, even the NT’s. i don’t like what they’re trying to say about us, but i can understand the researchers who want to make it easier to understand us and slap categories on us. i love labels, as long as they’re accurate, and reflect what’s really going on for me, or anyone else.
is it really that hard for researchers to imagine that a person can have traits that seemingly conflict or contradict, that our internal world can be so complex? isn’t it the same for everybody? i can see how it would be hard to write a paper, or a request for funding, that didn’t wrap up the subject matter (in this case, us) in a nice, tidy, easy to understand package.
-
John Dale Lyons July 3rd, 2009 at 8:45 am
Saja: Good reply; thanks. For years I have tried to act “normal” (NT), and now that I have a diagnosis I am oddly protective of that status. Go figure. I do know that I am an anomaly in some ways.
-
I hope it’s clear that I’m not overgeneralizing about autistic people having any one set of traits. Certainly, some autistic people are not particularly empathethic, and some autistic people have great spatial skills, but you could easily say the same for neuro-typical people. There is tremendous variety all along the spectrum.
To me, the underlying issue is the harm that can come from the experts’ easy generalizations. Terms like “mind-blindness” and “impaired empathy” are considered the defining traits of autism, not just the traits of some autistic people. From there, in the public mind, those easy generalizations can morph into stereotypes, and then into garden-variety fear and prejudice.
The whole empathy question, in particular, sets off all kinds of alarms for me. Empathy is so basic to being a human being that to generalize and say that impaired empathy is a hallmark of autism comes perilously close to denying our humanity. As such, it’s remarkably (and ironically) unempathetic.
-
John Dale Lyons July 3rd, 2009 at 1:31 pm
A difficulty in reading people, or in knowing how to react “appropriately” to a situation can also lead to misdiagnosis of lack of empathy. We are not sociopaths, just socially inept.
-
Rachel – I agree that some of the generalizations made about autistics are very alarming. My relating-to-others problems stem from an overabundance of empathy, if anything. Those dehumanizing generalizations, based on external behavior, may not be too damaging for you and me, but consider people like Amanda Baggs: nonverbal autistics who present with highly non-normal behavior, and are, based on external cues, determined to be retarded, unfeeling, antisocial, and a host of other things that absolutely do NOT apply. But the profoundly autistic can’t argue otherwise.
Ever since my daughter spent a year in a wheelchair and looked during the last months of her illness very much like someone retarded, I’ve made a point of making eye contact with everyone I pass who seems disabled. What are the chances that beneath the spastic exterior resides someone perfectly lucid and intelligent? Even if it only happens once in my lifetime, I will be overjoyed if I manage to affirm the humanity of someone who rarely gets treated like a person.
On generalizing a population: this already happens in the mainstream world, of course. There are technical definitions of normal (such as IQ test scores) that get applied to all of us, and not a single human being is “normal” in every respect. (And if there is one, well, that’s the exception that proves the rule: how abnormal is being normal in every single respect?
) And generalizations have their uses. Oaks aren’t elms, but it’s useful to have a category “tree” which represents their general commonalities. But people shouldn’t forget that generalizations have limited applicability–and when they do, that’s where the problems begin to get serious. -
Have you come across the ASD forum “Gestalt” ? It’s small, women are well-represented, and high-level intellectual topics come up on regular basis.
http://asdgestalt.com/index.php
Dunno’ if I can put a link to the site here, but there are discusssions by fellow aspies on the whole prenatal testosterone & “male brain” angle of Baron-Cohen’s.As a female who got Asperger’s dx late in life, I took the EQ & SQ tests in back of B-C’s “The Essential Difference” book. I got very low scores on both scales, which would indicate I do little of either systemizing or empathizing ? My NT boyfriend at the time took same quizzes & got high scores on both scales. Go figure…
Only recently found this blog, and I resonate with so much of what you’ve described throughout the posts. Thanks.
-
Hi Belfast, and welcome!
Thanks for the link to the Gestalt forum. I have a feeling I’ll be spending some time there.
-
Michelle July 4th, 2009 at 7:14 am
Hi Rachel,
I love reading your blog.
It’s vital to examine the flaws and assumptions made in such research. I was very much agreeing with your critique until I read the following point you made, on which I’d like to give feedback:
“Any difference in abilities between males and females can easily be explained not by brain structure, but by the ways in which girls are socialized and educated in western societies.”
Cognitive abilities and traits such as the one you mentioned have been studied through neuropsychological and other tests and do have a biological basis. Many studies investigate the neural correlates of such cognitive traits (for example, those associated with executive dysfunction.) Endophenotypes are also studied.
I felt the need to comment on this point because it reminded me of some of the assumptions of psychologists I have met who insist that all cognitive traits and neurologically-based issues can be explained purely by things like culture, social context, upbringing and gender roles. They are unaware of the research literature demonstrating the etiology of such traits and conditions is more complex than this, having strong genetic and neurobiological basis. This assumption is still prevalent among professionals today (the consequences of which I have had the misfortune of experiencing firsthand), and can result in harm. In many places today, eating disorders, anxiety disorders and autism are being blamed purely on nurture and environmental causes. This is in spite of it now being known there are innate predisposing risk factors involved, such as the cognitive style of detail-oriented processing associated with eating disorders. Cognitive traits and styles are to a large degree innate.
-
Hi Michelle,
You make an excellent point. In arguing against what I consider Baron-Cohen’s oversimplications about innate male and female traits, I overstated. What I meant to say is that any research that leaves the influence of culture out of the equation, especially concerning its effect on gender roles and gender identity, is fundamentally flawed. One cannot assert, with any assurance, that male and female traits have only a biological/neurological foundation any more than one can assert that they are only cultural constructs. The interaction between nature and nurture is too complex to develop a theory in which one trumps the other.
-
DonkeyBuster July 4th, 2009 at 2:06 pm
Loved your critique, Rachel. Very right on.
I wonder if the posit that stimming is a form of systematizing behavior may not be related to the systematizing integrative effects of EMDR, if you’ve ever experienced that treatment for PTSD. I’ve had positive effects from a form of that–the finger waving version– and it does remind me of finger flipping my profoundly autistic brother does when he’s happy.
I’m diagnosed AS (not surprisingly) and I stim when I’m severely stressed, which I am pretty darn good at avoiding by now. I do think the activity might have a similar action in the mind to the EMDR.
Just a thought…
DB -
I’ve done some EMDR therapy and it’s been very effective. I’m not sure about the relationship between stimming and EMDR, though. What they seem to have in common is the repetitive motion that somehow calms the system. But since no one really knows why EMDR works, it’s hard to tell whether it soothes the nervous system by the same mechanism that stimming does.
I was told by my OT not to do EMDR work while I was doing OT. When I mentioned it, she looked positively alarmed and said that it would severely overload my system. So that may be evidence that EMDR works differently from stimming. After all, she didn’t tell me to stay away from stimming altogether. In fact, she encouraged me to stim whenever I needed to.
-
Jennifer July 6th, 2009 at 9:33 am
I recet came across a syndrome which affects males, but who have an extra y chromosome (Klinefelter syndrome.) Many people with this syndrome have PDD nos too.
This seems to be added evidence against the extreme male brain theory in autism. -
Jennifer July 6th, 2009 at 9:37 am
Sorry! Correction to my previous post- I should have said an extra x chromosome.
(I’m a bit tired, please excuse my incompetence.) -
Jennifer, that’s really interesting. More grist for the mill!
Leave a Reply
Unique Visitors
8,964 | Unique Visitors |
